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May 1, 2012

Menopause Map Helps Women Navigate Treatment

by editor

Nationwide poll found 7 out of 10 women suffering from menopausal symptoms are not treated

Women going through menopause now have a first-of-its-kind interactive guide to help them better understand their menu of treatment options, including whether hormone therapy may be right for them. The Endocrine Society and its Hormone Health Network today released the "Menopause Map," an online tool to help women and their doctors discuss which hormonal and non-hormonal treatment options would be most effective and safe to relieve the sometimes debilitating symptoms of menopause. A new accompanying survey found that the majority of women facing challenging symptoms are concerned about hormone treatment and are not discussing it, or other non-hormonal options, with their doctor. The Map was developed by Endocrine Society physician experts who specialize in menopause management.

The tool is based on the latest unbiased research and is intended to jumpstart conversations between women and their doctors about the choices available to them as they approach and experience menopause.

Hormone therapy has been under intense scrutiny since 2002, when a large government study called the Women's Health Initiative http://www.nhlbi.nih.gov/whi/ (WHI) reported that hormone therapy–specifically the combination of estrogen and progestin together–increased the risk for blood clots, stroke, breast cancer and heart attacks. The researchers halted the study and concluded that the risks of hormone therapy outweighed the benefits. Although the study was designed to evaluate the role of hormone therapy in the prevention of diseases related to aging, many women and their doctors also abandoned it as therapy for menopausal symptoms.

Over the past 10 years, additional research has found that the level of risk depends on the individual woman, her health history, age, and the number of years since her menopause began. In general, younger women (under 60) who have recently started menopause are at a lower risk than older women when taking low doses of hormone therapy.

"Left with the false impression that hormone therapy isn't a safe option, far too many women have suffered in silence thinking their options for symptom relief were limited or non-existent," says Cynthia Stuenkel, MD, a member of The Endocrine Society and an endocrinologist specializing in menopause at the University of California, San Diego. "We know that for some women, hormonal therapy provides the only relief for severe menopausal symptoms. Women deserve some clear answers and helpful tools to engage their doctors in meaningful conversations about the multiple choices available to improve their menopausal symptoms."

When a woman enters menopause, she stops menstruating and her body produces less of the sex hormones estrogen and progesterone. The process of menopause takes years. During that time, women may experience moderate to severe symptoms, including hot flashes, interrupted sleep, vaginal dryness, and other symptoms that affect her quality of life.

The survey found that 72 percent of women currently experiencing symptoms have not received any treatment for them. Other findings include:

Majorities of menopausal women experiencing symptoms have not talked to their primary health care provider or OB/GYN about hormone therapy (62%) or non-hormone options (61%), and half of them have not talked about lifestyle changes;

Nearly half (49%) of menopausal women experiencing symptoms have a negative impression of hormone therapy; and

While the sample sizes of African Americans and Latinos in the survey are small, only 17 percent of African-American respondents say they have talked to their doctors about hormone therapy, compared to 39 percent of white women and 35 percent of Latinas, suggesting that disparities may exist.

"Unfortunately, as in many health care issues, significant disparities exist. Add to that, many primary care doctors don't have enough information about the latest research or what to prescribe," Dr. Stuenkel says. "We want to make health care providers across the nation aware of this tool so that they can facilitate better discussions with their patients."

The "Menopause Map" is an online interactive tool that guides a woman through the different options available to get relief from her symptoms through a series of prompting questions about those symptoms and her personal health history. The Map also has links to questionnaires that help assess current risk for breast cancer, heart disease, and stroke. The tool weighs hormonal and non-hormonal therapies against the risks based on individual symptoms and medical history.

The Map was not designed to be a self-diagnostic tool. It's recommended that women print out their results along with a list of provided questions to discuss the best treatment options for them with their provider. Women should revisit this tool to check their symptoms and have a continuous, informed dialogue with their provider.

The important facts to know about hormone therapy are:

Women 60 years and older should not use menopausal hormone therapy.
Women 50-59 years or younger, with no family or personal history of breast cancer, no history of heart disease or stroke, and with moderate to severe menopausal symptoms are the best candidates for hormone therapy.
If considering hormone therapy, women should talk with their health care provider to determine a plan that is right for them.
In addition, lifestyle approach also helps alleviate symptoms and benefit long-term health.
For those who decide on hormone therapy, this is an ongoing process and might require a period of trial and error to find the right fit for each individual woman.
For those who decide on non-hormonal options, there are several proven therapies available that may help with symptoms. It is important women share information about all medications they are using, including over-the-counter drugs and nutritional supplements, to make sure the choice of therapy doesn't interact with other medications.